Feasibility and efficacy of a digital cognitive behavioural therapy program for insomnia and anxiety for older adults

Insomnia and anxiety are highly prevalent and often comorbid in older adults. Although cognitive-behavioural therapy is the first-line treatment for insomnia, few interventions simultaneously address both conditions. Furthermore, access remains limited by provider availability and high costs. To address these gaps, we developed an online CBT program for insomnia and anxiety (eCBT+). This randomized controlled trial aimed to assess the usability and acceptability of the eCBT+ program and evaluate its efficacy in older adults with insomnia. Eighty older adults with insomnia were randomized to the eCBT+ intervention (n=38) or a waitlist (WL) control condition (n=42). Platform usability and program acceptability were assessed post-intervention using the System Usability Scale (SUS) questionnaire and the extended Technology Acceptance Model questionnaire. Insomnia and anxiety symptoms evaluated with the Insomnia Severity Index (ISI) and Geriatric Anxiety Inventory (GAI) respectively, along with sleep-diary sleep efficiency, were assessed at baseline and follow-up. Linear mixed models with an intention-to-treat approach assessed the Group*Time interaction. The platform was considered user-friendly (SUS=69.94%). Perceived ease of use, perceived usefulness, and result demonstrability were the main contributors to acceptability. The eCBT+ group showed reduced ISI and GAI and increased sleep efficiency, from baseline to follow-up, compared to the WL group (ps< .001). The eCBT+ program was user-friendly and its use was acceptable in older adults with insomnia. The program improved sleep efficiency and reduced insomnia and anxiety symptoms, demonstrating the efficacy of our eCBT+ intervention. Web-based tools offer a promising approach to promote sleep and mental health among older adults. (https://www.isrctn.com/ISRCTN15338211) KEYPOINTS{blacksquare} This randomized controlled trial evaluated the feasibility and efficacy of a digital cognitive behavioural therapy program for insomnia and anxiety, delivered through a platform tailored to older adults. {blacksquare}The platform was well accepted and considered user-friendly, with acceptability primarily explained by perceived ease of use, perceived usefulness and demonstrability of results. {blacksquare}The intervention demonstrated efficacy by improving sleep efficiency and reducing insomnia and anxiety symptoms. {blacksquare}This combined digital cognitive behavioural therapy for insomnia and anxiety represents an innovative, clinically relevant and accessible approach for older adults.